CHART - 1
Cl/h: 8 yrs child admitted with history of abrupt onset of malaise, fever, periorbital edema and
passing cola-colored urine since 2 days. O/E: Pt. is febrile, BP-160/100mm Hg, HR- 85/min,
RR-20/min: Urine examination showed the following features:
Physical Examination: Chemical Examination:
Quantity : 900 ml/day PH : 7.0
Colour : Smoky Albumin : present (+)
Appearance : Slightly Turbid Blood : Present (+)
Specificgravity : 1.030 Sugar : Absent
Ketone bodies : Absent
Microscopy:
Puscells : 0-1/hpf Epithelialcells : 0-1/hpf
RBCs : 10-20/hpf; dysmorphic Casts and Crystals : RBC casts 1-2/hpf
Answer The Following Questions:
1. What is the diagnosis?
2. What are the causes?
3. What other lab investigations should be done in the above case?
4. What is the prognosis in this case?
CHART - 2
Cl/h: A child came with complaints of facial puffiness, periorbital edema & anasarca. Urine
examination revealed marked albuminuria.
Laboratory findings :
Serum biochemical examinations shows hypoalbuminemia and hyperlipidemia
Physical Examination: Chemical Examination:
Quantity : 1400 ml/day Ph : 7.2
Colour : yellow Albumin : present (++++)
Appearance : Turbid Blood : Absent
Specific gravity : 1.030 Sugar : Absent
Ketone bodies: Absent
Microscopy:
Puscells : 2-3/hpf
Epithelial cells : 3-4/hpf
RBCs : Absent
Casts and Crystals : Absent
Answer the following questions:
1. What is your diagnosis &
2. Define the condition and enumerate the causes?
3. Mention any other investigations you would like to do?
4. How is the specific gravity corrected for altered protein levels?
CHART - 3
Cl/h: A female aged 40 yrs was admitted to the hospital with a history of recurrent fever,
loin pain since 4months. Urine examination showed the following features:
Physical Examination: Chemical Examination:
Quantity : 2000 ml/day ph : 6.8
Colour : Yellow Albumin : present (++)
Appearance : Turbid Blood : present (+)
Specific gravity : 1.030 Sugar : Absent
Ketonebodies : Absent
Microscopy:
Puscells : 30-40/hpf
Epithelialcells : 4-6/hpf
RBCs : 2-4/hpf
Casts and Crystals: Pus cell casts seen.
Answer the following questions:
1 .What is the diagnosis?
2 What are the causes for the above condition?
3 What other investigations would you like to do?
CHART - 4
Cl/h: A 30 year old female presented with a mobile lump in the right breast of 6 months
duration. Fine needle aspiration from the breast lump was performed.
Slide given below:
Answer the following questions:
1 . What is the diagnosis?
2 . What are the other investigations that should be done in the above case?
3 . How do you differentiate benign from malignant neoplasms of breast on clinical examination?
CHART - 5
Cl/h: A 48 year old female presented with a hard, immobile, painless lump in the right upper
outer quadrant of the breast. Fine needle aspiration from the breast lump was performed.
Slide given below:
Answer the following questions:
1 .What is the diagnosis?
2 . What are the other investigations that should be done in the given case?
3 What are the special investigations that determine the prognosis in the above condition?
.
CHART - 6
Cl/h: A 40 year old female presented with a post-coital bleeding.
Cervical smear given below for interpretation (Papanicolaou x 400)
Answer the following questions:
1. What is the diagnosis?
2. What are the other investigations that should be done in the above condition?
3. What are the risk factors for the development of the above condition?
CHART - 7
Cl/h: A 55-year-old chronic smoker with K/c/o Hypertension & Diabetes was brought to
emergency with complain of sudden chest pain & breathlessness since 6 hours. Chest Pain
was retro sternal and radiating to left arm. Pain increases by exertion and reduces by rest.
On Examination: BP - 160/90 mm Hg, HR – 22/min
Findings – ECG shows : ST segment elevation & T wave inversion
Answer the following questions:
1. What is the diagnosis?
2. What are the causes for the above condition?
3. Mention any other investigations you would like to do?
4. What are the complications?
CHART - 8
Cl/h: 14 years male presented with generalized weakness of 4 months duration.
O/E : pallor, hepatosplenomegaly, yellowish discolouration of sclera and high coloured urine since
10 days
Haematological parameters :
Hb % 6 gm% Urine Stool
Reticulocyte count 7% Bilirubin + Stercobilinogen +
Urobilinogen +
Biochemical findings :
Total Bilirubin 10 mg/dl HBs Ag Non reactive
Direct Bilirubin 2 mg/dl Serum Albumin 3.5 gm/dl
Indirect Bilirubin 8mg/dl Serum Globulin 3 gm/dl
Alkaline phosphatase 110IU/L PT 8 sec
SGOT 70IU/L Gama Glutamyl transferase 25 IU/L
SGPT 90IU/L
Answer the following Questions:
1. Interpret the peripheral smear given above?
2. What is the probable Diagnosis?
3. What are the various types of jaundice?
4. What other investigations you would like to do?
CHART – 9
Cl/h: 30 yrs old male presented with history of fever of 2 weeks duration, nausea and high
coloured urine.
O/E: There is enlargement and tenderness of abdomen.
Biochemical findings :
Total Bilirubin 11 mg/dl HBs Ag Reactive
Direct Bilirubin 7 mg/dl Serum Albumin 3.2 gm/dl
Indirect Bilirubin 4mg/dl Serum Globulin 3.1 gm/dl
Alkaline phosphatase 180 IU/L PT > 16 secs responding to
Vitamin K
SGOT 700 IU/L Gama Glutamyl transferase 30 IU/L
SGPT 650 IU/L
Answer the following questions:
1. Identify the organ and the condition in the above picture
2. What is the probable diagnosis & what are the possible causes of the above condition?
3. Interpret the above graph showing serological markers & give your diagnosis?
CHART - 10
Semen analysis:
Period of abstinence : 3 days
Amount : 3 ml
Appearance : Greywhite
Liquefaction : 15 minutes
PH : 8.0
Spermcount : 10 millions/ml
Motility : > 60% of sperms are actively motile
Morphology : > 65 % of sperms are ofnormal
Answer the following questions:
1 .What is the diagnosis?
2 . Mention the indications for semen analysis?
3 . What are the instructions that are to be given for collection of semen sample?
CHART -11
Cl/h: A 3 year old was brought to the hospital with a history of fever and vomiting 2 days
duration. O/E: Nuchal rigidity present. The CSF analysis showed the following features.
PARAMETER OBSERVED VALUE NORMAL RANGE
Volume 2 ml
Colour/Appearance Turbid Straw color
Total count 3400 cells/cumm O – 6 cells/ cumm
Differential count Neutrophils 95%
Lymphocytes 5%
Protein 316 mg/dl 20 – 50 mg/dl
Sugar 10 mg/dl 50 – 80mg/dl
Chloride 118 mEq/L 115-130mmol/l
LDH 96.1 IU/L < 80 IU/L
ADA 2.7 IU/L < 10 IU/L
Answer the following Questions:
1. What is the probable diagnosis?
2. Mention the organisms causing this condition in various ages?
3. Mention any other investigations you would like to do?
4. How do you differentiate it from other conditions?
CHART - 12
Cl/h: A 43 yrs old male was brought to the hospital with complaints of dizziness and vomiting for
10 days fever, headache, and neck stiffness for 2 days. He has past history of TB 10 yrs back and
was treated. CSF analysis showed the following features:
Pandy’s Test
Chemical Examination:
PARAMETER OBSERVED VALUE NORMAL RANGE
volume 2 ml
colour/Appearance Turbid
Total count 1200 cells/cumm O – 6 cells/ cumm
Differential count Lymphocytes 90 %
Neutrophils 10 %
Protein 292.6 mg/dl 20 – 50 mg/dl
Sugar 32 mg/dl 50 – 80mg/dl
Chloride 70 mEq/L 115-130mmol/l
LDH 113.4 IU/L < 40 IU/L
ADA 17.2 IU/L < 10 IU/L
Pandy’s test Positive
Answer the following Questions:
1. What is the probable diagnosis?
2. Mention the organisms causing this condition
3. Mention any other investigations you would like to do?
4. How do you differentiate it from other conditions?
5. What is pandy’s test?
CHART - 13
Cl/h: A 50 yrs old male presented with fever, vomiting and neck stiffness. He has past history of
renal transplantation 1 year back for end stage kidney disease and he is on immunosuppressive
agents. CSF findings are as follows:
Physical Examination: volume : 2ml, Colour/Appearance : clear
PARAMETER OBSERVED VALUE NORMAL RANGE
Total count 36 cells/cumm O – 6 cells/ cumm
Differential count Lymphocytes 100 %
Protein 68.6 mg/dl 20 – 50 mg/dl
Sugar 113.6 mg/dl 50 – 80mg/dl
Chloride 70 mEq/L 115-130mmol/l
LDH 52.4 IU/L < 40 IU/L
ADA 6.7 IU/L < 10 IU/L
Pandy’s test Positive
Answer the following Questions :
1. What is the probable diagnosis?
2. Mention the organisms causing this condition?
3. Mention any other investigations you would like to do & what is the confirmatory test?
4. Describe Indian Ink preparation test?
CHART - 14
Cl/h: A 50 yrs old female complaints of progressive weight gain, fatigue deepening of voice, dry
skin constipation, cold intolerance and bradycardia. On examination thyroid gland swelling is seen
with delayed deep tendon reflexes. Labroratory findings include:
Total serum T4 3.8 ug/dl
Serum free T4 0.3ng/dl
Serum free T3 200 pg/ml
Serum TSH 10 mIU/L
Answer the following questions :
1. What is your diagnosis?
2. What are the various causes for this condition?
3. What are the Normal thyroid profile values?
4. Interpret thyroid profile in this case and come to conclusion?
CHART – 15
Cl/h: A 58 yrs old female complaints of progressive weight gain, fatigue, heavy menstruations
poor memory and myxedema are seen. On examination diffuse swelling of thyroid gland seen with
many associated clinical features as shown in the picture below.
Laboratory findings:
Total serum T4 5.6 ug/dl
Serum free T4 16 ng/dl
Serum free T3 4.5 pmol/L
Serum TSH 6.8 mIU/L
Answer the following questions:
1. What is the clinical diagnosis?
2. What is the etiology & pathogenesis for this condition?
3. Interpret thyroid profile in this case and come to conclusion?
4. Describe histopathology features of this condition?
5. What is the additional biochemical test for this condition?
CHART – 16
Cl/h: A 30 yrs old pregnant female prerented with history of generalized weakness and fatigue
since 3 weeks.
Investigations:
Hb : 4.6gm%
TC : 5600 cells/cmm,
Platelets : 4.6 lakhs/cmm,
PCV : 17.2%,
MCV : 55.7 fl,
MCH : 14.9pg,
MCHC : 26.7g/dl,
RDW – CV : 20.3%
Answer the following questions ;
1. Interpret the given values & smear and What is the diagnosis?
2. What are the most common causes for this blood picture?
3. What are the investigations to be done to confirm the above case?
4. What are the differential diagnoses and what are the investigations to be done for them?
5. Write any special investigations to do in the above case?
CHART – 17
Cl/h: A 30 year old male with ileal resection done 2 years back presented with anaemia.
Peripheral smear & Bone marrow findings given below:
Hb : 5.8gm%,
TLC : 2300/cmm,
RBC : 1.16million/cmm,
Platelets : 1.66lakhs/cmm,
PCV : 15.8%.
MCV :136fl,
MCH : 50 pg,
MCHC : 36.7 g/dl,
RDWCV : 18.6%
Answer the following questions:
1. Interpret the lab investigations, PS and bone marrow picture?
2. What are the causes for the above bone marrow picture?
3. What will be the blood picture in this case?
4. List other investigations you would like to do?
CHART – 18
Cl/h: A 12 year old female child with repeated painful swelling of the hands and feet.
PERIPHERAL SMEAR GIVEN BELOW:
Answer the following questions:
1. What is the diagnosis, Interpret the PS?
2. List other investigations necessary for the diagnosis?
3. What are the other clinical features?
4. Why is the patient having repeated attacks of bone pain?
CHART – 19
Cl/h: A 1 year old child presented with failure to thrive and irritability.
O/E: Hepatosplenomegaly were noticed.
INVESTIGATIONS:
Hb: 5,7 gm %,
Corrected WBC count: 25,000cells/c.mm,
DC: N56/L32/M10/E02/B00/
NRBCs-28/100WBCs,
RBC:2.33mill/c.mm,
Hct: 18%,
MCV: 77.3fl,
MCH: 24.5PG,
MCHC: 31.7g%,
Plt: 1,73lakh/c.mm.
PERIPHERAL SMEAR GIVEN BELOW:
Answer the following questions:
1 .What is the diagnosis?
2. List other investigations you would like to do and what findings do you expect?
3. What are the follow up investigations to be done in case of repeated transfusions in the
above condition?
CHART – 20
Cl/h: One day old neonate, peripheral smear and special stain for interpretation.
PERIPHERAL SMEAR SPECIAL STAIN IS DONE:
Answer the following questions:
1. What is your observation & diagnosis?
2. What is the normal count & List the conditions in which it is increased?
3. What is the corrected count of the above cells?
4. What are the investigations would you like to do?
CHART – 21
Cl/h : A 19 yrs old presented with high grade fever with chills & rigors. PS for evaluation.
Answer the following questions:
1. What is the diagnosis?
2. What are the conditions in which above cells are increased and decreased?
CHART – 22
Cl/h : A 38 yrs old male presented with fever, body pains. PS for evaluation:
Answer the following questions:
1. What is the diagnosis?
2. What are the causes for the above condition?
3. Mention few conditions where the above cells are increased and decreased?
CHART – 23
Cl/h : 26 yrs old male known allellrgic patient presented with fever, breathlessness.
PS for evaluation
Answer the following questions :
1. What is the diagnosis?
2. What is the normal count & What are the conditions in which the count is increased?
3. What is the absolute count measured in the above condition?
CHART – 24
Cl/h : A 30 yrs female presented with weakness, fatigue, pallor, loss of appetite, burning
sensation in hands and feet. PS for evaluation.
Answer the following questions:
1. Whar is the characteristic peripheral smear finding?
2. What are the causes for the above condition?
3. List the investigations you would like to do?
CHART – 25
Cl/h: A 5 year old child presented with fatigue, bone pain and painless cervical and axillary
lymphadenopathy. O/E: pallor and diffuse petechiae.
INVESTIGATIONS:
Hb: 8.9 gm %,
Total LC: 45,750cells/cumm
Platelet count : 25,000 cells/cumm
Peripheral smear given below
Answer the following questions:
1. What is the diagnosis & describe the cells in Peripheral smear
2. How will you classify above condition?
3. Which immunochemical stains will be positive in the above case?
4. Which are the factors associated with unfavorable prognosis?
CHART – 26
Cl/h: A 20 year old male presented with a history of bleeding gums.
INVESTIGATIONS:
Hb: 8 gm %
TLC: 92,000 cells/cumm
Plateletcount: 70,000 cells/cumm
PERIPHERAL SMEAR GIVENBELOW:
Answer the following questions:
1. What is the diagnosis & How will you classify?
2. Describe the cells seen in the picture?
3. What percentage of blasts should be seen in acute leukemias?
4. What is the cytogenetic abnormality seen in AML M3, and what is its significance?
5. Which innunochemical stain will be positive in the above case?
CHART – 26
Cl/h: An elderly female patient presented with fullness of abdomen, dragging pain since seven
days. History of fatigue anorexia, weakness, weight loss, night sweats and low grade fever with
loss of appetite were present. On ultrasonography, massive splenomegaly was noted.
Laboratory findings showed raised serum uric acid and serum LDH and decreased LAP score.
Gross image of spleen, peripheral smear study, cytogenetics study images were shown below.
Based on the clinical details, lab findings provided Answer the following questions:
1. What is the diagnosis?
2. Discuss peripheral blood smear, bone marrow, biochemical findings?
3. Discuss about characteristic chromosomal abnormality associated with this condition?
4. What is the WHO classification?
5. What are the different phases of above condition?
CHART – 27
Cl/h: A female patient aged 60 years came for annual routine checkup.
O/E: generalized lymphadenopathy and hepatosplenomegaly were noted.
INVESTIGATIONS:
Hb: 9 gm %
TLC: 90,000/cumm
Platelet count: 1.2lakhs/cumm
PERIPHERAL SMEAR GIVEN BELOW:
Answer the following questions:
1. What is the diagnosis based on the above peripheral smear findings?
2. How do you stage this disease?
3. What is the stage in the above case?
4. What are the prognostic factors?
CHART – 28
Cl/h : 56 yrs malel presented with progressive anaemia, fatigue, weakness and bone pains. O/E he
has pallor, pathological fractures of vertebra and cord compression
Laboratory findings:
Hb : 8 gm/dl ,
TLC : 10000/cmm,
ESR : 110mm/1st hour
Serum Calcium : 12.5gm%,
Serum Creatinine : 2.5 gm% and
Bence jones proteins in urine.
Answer the following questions:
1. What is your diagnosis & what are the criteria for the diagnosis?
2. What are the findings in peripheral smear, bone marrow aspiration and bone marrow biopsy?
3. What are the other investigations?
4. What is Bence Jones proteineuria? What is its importance?
CHART – 30
Cl/h: A 22 year oldpresented with fever, chills & rigors.
PERIPHERAL SMEAR GIVEN BELOW:
Answer the following questions:
1. What is the diagnosis?
2. What are the other causes for the above symptoms?
3. Mention other haemoparasites?
CHART – 31
Cl/h: A 42 year old male presented with diffuse swelling of the left lower limb since 10 years.
PERIPHERAL SMEAR GIVEN BELOW:
Answer the following questions:
1. What is the form seen in the blood smear?
2. Mention other Haemoparasites?
3. What is the drug of choice for the above condition?
4. What is the ideal way to collect the blood sample for the above condition?
